Transfusion medicine US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Transfusion medicine. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Transfusion medicine US Medical PG Question 1: A 26-year-old woman is brought to the emergency department after a motor vehicle accident. She was driving on the highway when she was struck by a van. At the hospital she was conscious but was bleeding heavily from an open wound in her left leg. Pulse is 120/min and blood pressure is 96/68 mm Hg. She receives 3 L of intravenous saline and her pulse slowed to 80/min and blood pressure elevated to 116/70 mm Hg. The next morning she is found to have a hemoglobin of 6.2 g/dL. Her team decides to transfuse 1 unit of packed RBCs. Twenty minutes into the transfusion she develops a diffuse urticarial rash, wheezing, fever, and hypotension. The transfusion is immediately stopped and intramuscular epinephrine is administered. Which of the following scenarios is most consistent with this patient's reaction to the blood transfusion?
- A. A patient history of cardiovascular disease
- B. Unsanitary blood product storage practices in the hospital
- C. A patient history of frequent sinopulmonary infections (Correct Answer)
- D. Facial twitching when the patient's cheek is tapped
- E. Prior transfusion reactions caused by the same donor
Transfusion medicine Explanation: ***A patient history of frequent sinopulmonary infections***
- The diffuse **urticarial rash, wheezing, fever, and hypotension** after a blood transfusion are classic signs of a **severe allergic reaction (anaphylaxis)**.
- Patients with a history of frequent sinopulmonary infections often have **IgA deficiency**, which can lead to the formation of anti-IgA antibodies. If transfused with blood containing IgA, these antibodies can trigger a severe anaphylactic reaction.
*A patient history of cardiovascular disease*
- While cardiovascular disease can influence how a patient tolerates a transfusion, it does not directly cause the specific constellation of symptoms like **urticaria, wheezing, and fever** that point to an allergic reaction.
- Cardiovascular issues might exacerbate circulatory collapse but wouldn't be the primary cause of an immediate, systemic allergic response.
*Unsanitary blood product storage practices in the hospital*
- Unsanitary storage practices are typically associated with **bacterial contamination** of blood products, leading to a **febrile non-hemolytic transfusion reaction** or **septic shock**, often with severe rigors and high fever.
- This scenario would not commonly present with prominent **urticaria and wheezing** as primary symptoms of an acute reaction.
*Facial twitching when the patient's cheek is tapped*
- Facial twitching when the cheek is tapped is known as **Chvostek's sign**, which is indicative of **hypocalcemia**.
- While rapid transfusion of large volumes of blood can sometimes lead to hypocalcemia due to citrate binding, the primary symptoms described (urticaria, wheezing, fever, hypotension) are not typical of hypocalcemia and point more strongly to an allergic reaction.
*Prior transfusion reactions caused by the same donor*
- While prior reactions to blood from the same donor could occur, it is highly unlikely in this scenario as blood components are typically sourced from various donors.
- The focus is on the patient's intrinsic predisposition (like IgA deficiency) rather than a specific donor incompatibility, especially since this is likely her first transfusion given the trauma.
Transfusion medicine US Medical PG Question 2: A 35-year-old patient is brought into the emergency department post motor vehicle crash. Stabilization of the patient in the trauma bay requires endotracheal intubation. The patient has a laceration on the femoral artery from shrapnel and seems to have lost large quantities of blood. The patient is transfused with 13 units of packed red blood cells. His vitals are T 96.5, HR 150, BP 90/40. Even with the direct pressure on the femoral artery, the patient continues to bleed. Results of labs drawn within the last hour are pending. Which of the following is most likely to stop the bleeding in this patient?
- A. Normal saline
- B. Fresh frozen plasma and platelets (Correct Answer)
- C. Whole blood
- D. Dextrose
- E. Cryoprecipitate
Transfusion medicine Explanation: ***Fresh frozen plasma and platelets***
- This patient is experiencing **dilutional coagulopathy** due to massive transfusion of packed red blood cells, which lack clotting factors and platelets.
- **Fresh frozen plasma (FFP)** provides essential clotting factors, while **platelets** directly address thrombocytopenia, both crucial for **hemostasis**.
- This represents **standard component therapy** readily available in emergency departments.
*Normal saline*
- Administering normal saline would further dilute the remaining clotting factors and platelets, potentially **worsening the coagulopathy**.
- While essential for **volume resuscitation**, it does not provide any clotting components needed to stop bleeding.
*Whole blood*
- While **whole blood** contains red blood cells, plasma, and platelets in physiologic ratios, it is **not readily available** in most civilian trauma centers.
- Modern practice uses **component therapy** (FFP + platelets + PRBCs) which is more widely accessible and allows for targeted resuscitation.
- Low-titer O whole blood programs exist in some centers but are not universally available.
*Dextrose*
- **Dextrose solutions** primarily provide free water and glucose, used for hydration and hypoglycemia.
- It has **no hemostatic properties** and would further dilute clotting factors, exacerbating the bleeding.
*Cryoprecipitate*
- **Cryoprecipitate** is rich in **fibrinogen, factor VIII, factor XIII, and von Willebrand factor**.
- While useful for specific factor deficiencies or when fibrinogen is critically low in massive transfusions, it **does not replace all clotting factors or platelets** comprehensively as FFP and platelets would.
- Typically used as **adjunctive therapy** when fibrinogen levels are known to be low.
Transfusion medicine US Medical PG Question 3: A 34-year-old primigravida was brought to an obstetric clinic with a chief complaint of painless vaginal bleeding. She was diagnosed with placenta praevia and transfused with 2 units of whole blood. Five hours after the transfusion, she developed a fever and chills. How could the current situation be prevented?
- A. Administering prophylactic epinephrine
- B. ABO grouping and Rh typing before transfusion
- C. Transfusing leukocyte reduced blood products (Correct Answer)
- D. Performing Coombs test before transfusion
- E. Administering prophylactic immunoglobulins
Transfusion medicine Explanation: ***Transfusing leukocyte reduced blood products***
- The patient's symptoms of **fever and chills** occurring hours after transfusion are characteristic of a **febrile non-hemolytic transfusion reaction (FNHTR)**.
- FNHTRs are caused by residual **donor leukocytes** in the transfused blood product, which release **cytokines** during storage or react with recipient antibodies, and can be prevented by using **leukoreduced blood products**.
*Administering prophylactic epinephrine*
- **Epinephrine** is used to treat severe **anaphylactic and allergic reactions** but does not prevent the underlying mechanism of FNHTRs.
- Its prophylactic administration is not a standard practice for preventing transfusion reactions like FNHTRs.
*ABO grouping and Rh typing before transfusion*
- **ABO grouping and Rh typing** are crucial for preventing **acute hemolytic transfusion reactions**, which are much more severe and involve erythrocyte incompatibility.
- These tests would not prevent a **febrile non-hemolytic transfusion reaction (FNHTR)** caused by leukocyte components.
*Performing Coombs test before transfusion*
- The **Coombs test (Direct Antiglobulin Test)** detects antibodies attached to red blood cells and is primarily used to diagnose **autoimmune hemolytic anemia** or delayed hemolytic transfusion reactions.
- It does not prevent FNHTRs, which are unrelated to red blood cell incompatibility or antibody-mediated hemolysis.
*Administering prophylactic immunoglobulins*
- **Prophylactic immunoglobulins** are used in specific situations like **immunodeficiency** or **Rh incompatibility (RhoGAM)** to prevent alloimmunization, but not for preventing FNHTRs.
- This intervention would not target the mechanism leading to fever and chills caused by donor leukocyte interactions.
Transfusion medicine US Medical PG Question 4: A 43-year-old man presents to the emergency department following a work-related accident in which both arms were amputated. The patient lost a substantial amount of blood prior to arrival, and his bleeding is difficult to control due to arterial damage and wound contamination with debris. His complete blood count (CBC) is significant for a hemoglobin (Hgb) level of 5.3 g/dL. The trauma surgery resident initiates the massive transfusion protocol and orders whole blood, O negative, which she explains is the universal donor. The patient receives 6 units of O negative blood prior to admission. He subsequently develops fever, chills, hematuria, and pulmonary edema. Several hours later, the patient goes into hemodynamic shock requiring the emergent administration of vasopressors. Of the following options, which hypersensitivity reaction occurred?
- A. Type 1 hypersensitivity reaction
- B. Combined type 1 and type 4 hypersensitivity reaction
- C. Type 3 hypersensitivity reaction
- D. Type 2 hypersensitivity reaction (Correct Answer)
- E. Type 4 hypersensitivity reaction
Transfusion medicine Explanation: ***Type 2 hypersensitivity reaction***
- This scenario describes an **acute hemolytic transfusion reaction (AHTR)**, a classic example of a **Type II hypersensitivity reaction**. The recipient's antibodies (IgM) recognize and bind to antigens on the transfused red blood cells, leading to their destruction (hemolysis) via complement activation and cellular mechanisms.
- Symptoms like **fever, chills, hematuria (due to hemoglobinuria)**, and subsequent **shock** are characteristic of AHTR, even with O negative blood if other minor blood group antigens (e.g., Kell, Duffy) are incompatible or if the patient developed antibodies against these from previous transfusions or pregnancies.
*Type 1 hypersensitivity reaction*
- This type involves **IgE-mediated mast cell degranulation** and is associated with allergic reactions such as anaphylaxis, asthma, and hives.
- While anaphylaxis can cause shock, the systemic symptoms of **hemolysis and hematuria** are not characteristic of a Type 1 reaction.
*Combined type 1 and type 4 hypersensitivity reaction*
- This combination is uncommon in an acute transfusion setting and does not align with the presented symptoms.
- Type 1 is immediate allergic, and Type 4 is delayed cell-mediated, neither fully explaining the hemolytic features observed.
*Type 3 hypersensitivity reaction*
- This reaction involves the formation of **immune complexes** (antigen-antibody complexes) that deposit in tissues, leading to inflammation and damage (e.g., serum sickness, lupus nephritis).
- While immune complexes can cause systemic symptoms, the prominent hemolytic features and immediate presentation of a transfusion reaction are more indicative of Type 2.
*Type 4 hypersensitivity reaction*
- This is a **delayed type hypersensitivity** reaction mediated by **T cells**, taking 24-72 hours or longer to develop (e.g., contact dermatitis, tuberculin skin test).
- The acute onset of symptoms following transfusion makes a Type 4 reaction highly unlikely.
Transfusion medicine US Medical PG Question 5: A 16-year-old boy is brought to the emergency department following a car accident in which he suffered multiple injuries. He is accompanied by his mother. She reports that his medical history is notable only for recurrent sinusitis and otitis as a child. He lost a significant amount of blood from the accident, and he is transfused two units of O-negative blood on arrival at the emergency department. Shortly thereafter, he complains of itching and increasing shortness of breath. He develops stridor. Which of the following could have prevented this reaction?
- A. Administering IVIG with transfusion
- B. Pre-transfusion diphenhydramine
- C. Administering washed blood products (Correct Answer)
- D. Pre-transfusion acetaminophen
- E. Administering type-specific blood
Transfusion medicine Explanation: ***Administering washed blood products***
- The patient's history of recurrent sinusitis and otitis suggests **IgA deficiency**, making him susceptible to anaphylactic reactions from IgA in transfused blood.
- **Washed blood products** remove plasma proteins, including IgA, preventing such reactions in IgA-deficient individuals.
*Administering IVIG with transfusion*
- **IVIG** contains IgA and could potentially worsen an IgA-mediated anaphylactic reaction in an IgA-deficient patient.
- It is used to supplement antibodies in immunodeficiency, but not to prevent allergic reactions to blood products in this context.
*Pre-transfusion diphenhydramine*
- **Diphenhydramine**, an antihistamine, can alleviate mild allergic reactions but is insufficient to prevent or treat life-threatening anaphylaxis.
- It does not remove the offending allergen (IgA) from the blood product.
*Pre-transfusion acetaminophen*
- **Acetaminophen** is an antipyretic and analgesic, used to manage fever or pain.
- It has no role in preventing allergic or anaphylactic transfusion reactions mediated by IgA.
*Administering type-specific blood*
- While essential for preventing **hemolytic transfusion reactions** due to ABO incompatibility, type-specific blood does not address reactions to plasma proteins like IgA.
- The patient's reaction is an **anaphylactic response**, not a hemolytic one.
Transfusion medicine US Medical PG Question 6: A 36-year-old man presents with massive hematemesis. Past medical history is significant for a gastric ulcer. He has a pulse of 115/min, respiratory rate of 20/min, temperature of 36°C (96.8°F), and blood pressure of 90/59 mm Hg. The patient receives a transfusion of 2 units of packed red blood cells. Around 5–10 minutes after the transfusion, he starts having chills, pain in the lumbar region, and oliguria. His vital signs change to pulse of 118/min, respiratory rate of 19/min, temperature of 38°C (100.4°F), and blood pressure of 60/40 mm Hg. Which of the following is the most likely cause of this patient’s condition?
- A. Febrile non-hemolytic transfusion reaction
- B. Acute hemolytic transfusion reaction (Correct Answer)
- C. Transfusion-associated sepsis
- D. Transfusion-related acute lung injury
- E. Anaphylactic transfusion reaction
Transfusion medicine Explanation: ***Acute hemolytic transfusion reaction***
- The rapid onset of **fever**, **chills**, **lumbar pain**, **oliguria**, and **hypotension** immediately after a blood transfusion is highly indicative of an acute hemolytic transfusion reaction (AHTR).
- This reaction results from **intravascular hemolysis** due to recipient antibodies (usually ABO incompatibility) reacting with donor red blood cells.
*Febrile non-hemolytic transfusion reaction*
- This reaction typically presents with **fever and chills**, but it lacks the severe symptoms of **renal failure (oliguria)** and profound **hypotension** seen in this patient.
- It is usually caused by cytokines released from donor leukocytes or recipient antibodies to white blood cell antigens.
*Transfusion-associated sepsis*
- While sepsis can present with fever and hypotension, it typically involves a **delay in onset** after transfusion as bacterial growth takes time, and the patient's initial symptoms are too immediate (5-10 minutes).
- This condition is usually due to **bacterial contamination** in the transfused blood product.
*Transfusion-related acute lung injury*
- TRALI primarily manifests as **acute respiratory distress**, including hypoxemia and bilateral pulmonary infiltrates, which are not described in this patient's symptoms.
- While fever and hypotension can occur, the prominent **lumbar pain** and **oliguria** point away from TRALI.
*Anaphylactic transfusion reaction*
- Anaphylaxis would also present with rapid onset but would typically include widespread **urticaria**, **angioedema**, **bronchospasm**, or severe respiratory distress, which are absent in this presentation.
- It usually occurs in patients with **IgA deficiency** who develop anti-IgA antibodies.
Transfusion medicine US Medical PG Question 7: A 22-year-old woman in the intensive care unit has had persistent oozing from the margins of wounds for 2 hours that is not controlled by pressure bandages. She was admitted to the hospital 13 hours ago following a high-speed motor vehicle collision. Initial focused assessment with sonography for trauma was negative. An x-ray survey showed opacification of the right lung field and fractures of multiple ribs, the tibia, fibula, calcaneus, right acetabulum, and bilateral pubic rami. Laboratory studies showed a hemoglobin concentration of 14.8 g/dL, leukocyte count of 10,300/mm3, platelet count of 175,000/mm3, and blood glucose concentration of 77 mg/dL. Infusion of 0.9% saline was begun. Multiple lacerations on the forehead and extremities were sutured, and fractures were stabilized. Repeat laboratory studies now show a hemoglobin concentration of 12.4 g/dL, platelet count of 102,000/mm3, prothrombin time of 26 seconds (INR=1.8), and activated partial thromboplastin time of 63 seconds. Which of the following is the next best step in management?
- A. Transfuse packed RBC
- B. Transfuse packed RBC and fresh frozen plasma in a 1:1 ratio
- C. Transfuse fresh frozen plasma and platelet concentrate in a 1:1 ratio
- D. Transfuse whole blood and administer vitamin K
- E. Transfuse packed RBC, fresh frozen plasma, and platelet concentrate in a 1:1:1 ratio (Correct Answer)
Transfusion medicine Explanation: ***Transfuse packed RBC, fresh frozen plasma, and platelet concentrate in a 1:1:1 ratio***
- The patient exhibits signs of **massive hemorrhage and coagulopathy** (persistent oozing, decreasing hemoglobin, prolonged PT and aPTT, decreasing platelets) following severe trauma.
- A **1:1:1 ratio transfusion** of packed red blood cells (RBCs), fresh frozen plasma (FFP), and platelet concentrate is the recommended **massive transfusion protocol** to address hypovolemia, anemia, and consumptive coagulopathy simultaneously.
*Transfuse packed RBC*
- While the patient is anemic (Hb dropped from 14.8 to 12.4 g/dL), transfusing only RBCs would not address the significant **coagulopathy** evidenced by prolonged PT/aPTT and decreasing platelets.
- This option would correct **hypovolemia and oxygen-carrying capacity** but fail to resolve the underlying bleeding disorder, potentially worsening hemorrhage.
*Transfuse packed RBC and fresh frozen plasma in a 1:1 ratio*
- This approach addresses **anemia and coagulopathy** by providing clotting factors, but it neglects the patient's **thrombocytopenia** (platelets dropped from 175,000 to 102,000/mm3 with ongoing bleeding).
- Platelet transfusion is crucial for **hemostasis**, especially in uncontrolled traumatic bleeding.
*Transfuse fresh frozen plasma and platelet concentrate in a 1:1 ratio*
- This option targets **coagulopathy and thrombocytopenia** but completely ignores the significant **anemia and hypovolemia** (Hb 12.4 g/dL with ongoing bleeding) that is likely contributing to hypoperfusion.
- **RBCs** are essential to restore oxygen delivery to tissues and manage hemorrhagic shock.
*Transfuse whole blood and administer vitamin K*
- **Whole blood** is rarely used in civilian trauma settings due to practical limitations, and its components can be provided separately.
- **Vitamin K** is primarily used for warfarin reversal or vitamin K deficiency, which is not the acute cause of coagulopathy in severe trauma; the issue is **dilutional and consumptive coagulopathy**.
Transfusion medicine US Medical PG Question 8: A 72-year-old man with coronary artery disease comes to the emergency department because of chest pain and shortness of breath for the past 3 hours. Troponin levels are elevated and an ECG shows ST-elevations in the precordial leads. Revascularization with percutaneous coronary intervention is performed, and a stent is successfully placed in the left anterior descending artery. Two days later, he complains of worsening shortness of breath. Pulse oximetry on 3L of nasal cannula shows an oxygen saturation of 89%. An x-ray of the chest shows distended pulmonary veins, small horizontal lines at the lung bases, and blunting of the costophrenic angles bilaterally. Which of the following findings would be most likely on a ventilation-perfusion scan of this patient?
- A. Matched ventilation and perfusion bilaterally
- B. Normal ventilation with multiple, bilateral perfusion defects
- C. Normal perfusion with bilateral ventilation defects (Correct Answer)
- D. Normal perfusion with decreased ventilation at the right base
- E. Increased apical ventilation with normal perfusion bilaterally
Transfusion medicine Explanation: ***Normal perfusion with bilateral ventilation defects***
- The patient's presentation with **worsening shortness of breath** after an acute coronary event, along with chest x-ray findings of **distended pulmonary veins, Kerley B lines (small horizontal lines at the lung bases), and blunting of the costophrenic angles**, is highly suggestive of **pulmonary edema** due to heart failure.
- In pulmonary edema, the alveoli fill with fluid, impeding gas exchange. This leads to **impaired ventilation** in the affected areas, while **pulmonary blood flow (perfusion) remains intact**. This results in **ventilation-perfusion (V/Q) mismatch** with impaired ventilation.
*Matched ventilation and perfusion bilaterally*
- This pattern would indicate a **normal ventilation-perfusion scan**, which is inconsistent with the patient's severe shortness of breath, hypoxemia, and radiographic signs of pulmonary edema.
- A matched V/Q scan suggests **healthy lung function** and gas exchange.
*Normal ventilation with multiple, bilateral perfusion defects*
- This pattern is characteristic of **pulmonary embolism**, where blood clots obstruct pulmonary arteries, leading to areas of the lung being ventilated but not perfused.
- The clinical picture and chest x-ray findings in this patient are not consistent with pulmonary embolism.
*Normal perfusion with decreased ventilation at the right base*
- While a focal ventilation defect could occur, the patient's symptoms and chest x-ray findings (distended pulmonary veins, Kerley B lines, bilateral blunting of costophrenic angles) suggest **generalized rather than localized pulmonary edema**.
- This option describes a unilateral and focal issue, whereas heart failure typically causes bilateral findings.
*Increased apical ventilation with normal perfusion bilaterally*
- This finding is not typical in any common pulmonary pathology. Increased apical ventilation is not a characteristic of pulmonary edema or other V/Q mismatch disorders.
- This scenario does not align with the patient's symptoms or imaging findings.
Transfusion medicine US Medical PG Question 9: A 25-year-old man comes to the emergency department because of a 1-week-history of progressively worsening dyspnea and intermittent chest pain that increases on inspiration. He had an upper respiratory tract infection 2 weeks ago. His pulse is 115/min and blood pressure is 100/65 mm Hg. Examination shows inspiratory crackles bilaterally. His serum troponin I is 0.21 ng/mL (N < 0.1). An x-ray of the chest shows an enlarged cardiac silhouette and prominent vascular markings in both lung fields; costophrenic angles are blunted. A rhythm strip shows inverted T waves. Which of the following additional findings is most likely in this patient's condition?
- A. Opening snap with low-pitched diastolic rumble
- B. Elevated brain natriuretic peptide (Correct Answer)
- C. Sarcomere duplication
- D. Right ventricular dilation
- E. Electrical alternans
Transfusion medicine Explanation: ***Elevated brain natriuretic peptide***
- This patient presents with symptoms of **dyspnea**, **chest pain**, **tachycardia**, elevated **troponin I**, an enlarged **cardiac silhouette** with prominent vascular markings, and **blunted costophrenic angles**, all consistent with **cardiomyopathy** and heart failure, likely post-viral **myocarditis**.
- **Brain natriuretic peptide (BNP)** is released by myocardial cells in response to ventricular stretch and volume overload, making it a strong indicator for **heart failure**.
*Opening snap with low-pitched diastolic rumble*
- An **opening snap** followed by a **low-pitched diastolic rumble** is characteristic of **mitral stenosis**, a valvular disorder not suggested by the patient's acute presentation and other findings.
- Mitral stenosis would typically be associated with a history of **rheumatic fever** and more specific echocardiographic findings of valve abnormalities.
*Sarcomere duplication*
- **Sarcomere duplication** and disarray are characteristic pathological findings in **hypertrophic cardiomyopathy (HCM)**, an inherited genetic disorder.
- While HCM can cause dyspnea and chest pain, this patient's acute presentation following a viral infection and evidence of fluid overload are more indicative of an **acquired cardiomyopathy** such as myocarditis.
*Right ventricular dilation*
- While the patient has signs of **heart failure**, the chest X-ray shows an **enlarged cardiac silhouette** and **prominent vascular markings in both lung fields** and **blunted costophrenic angles**, suggesting **left ventricular failure** with fluid redistribution and pleural effusions.
- Significant **right ventricular dilation** would typically be associated with signs of right-sided heart failure like **peripheral edema** and **jugular venous distension**, which are not explicitly mentioned as primary findings.
*Electrical alternans*
- **Electrical alternans** is a specific ECG finding characterized by beat-to-beat variation in the QRS amplitude or axis, most commonly associated with **pericardial effusion** leading to cardiac tamponade.
- Although the patient has an enlarged cardiac silhouette, which could indicate effusion, the primary findings point more broadly to **myocardial dysfunction** and **heart failure** rather than tamponade.
Transfusion medicine US Medical PG Question 10: A 65-year-old man presents to the emergency department due to an episode of lightheadedness. The patient was working at his garage workbench when he felt like he was going to faint. His temperature is 98.8°F (37.1°C), blood pressure is 125/62 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below.
Hemoglobin: 7 g/dL
Hematocrit: 22%
Leukocyte count: 6,500/mm^3 with normal differential
Platelet count: 197,000/mm^3
The patient is started on blood products and a CT scan is ordered. Several minutes later, his temperature is 99.5°F (37.5°C), blood pressure is 87/48 mmHg, and pulse is 180/min. The patient's breathing is labored. Which of the following is also likely to be true?
- A. Anaphylactic reaction (Correct Answer)
- B. Febrile non-hemolytic transfusion reaction
- C. Acute hemolytic transfusion reaction
- D. Transfusion-related acute lung injury (TRALI)
- E. Bacterial contamination of blood products
Transfusion medicine Explanation: ***Anaphylactic reaction***
- The rapid onset of **hypotension**, **tachycardia**, and **respiratory distress** immediately following blood product administration is highly suggestive of an anaphylactic reaction.
- This severe allergic reaction occurs within **minutes** of exposure and can rapidly progress to **shock** and **airway compromise**.
- The profound cardiovascular collapse with respiratory distress is the hallmark presentation.
*Febrile non-hemolytic transfusion reaction*
- Characterized by **fever** and **chills** within several hours of transfusion.
- Typically does **not** cause the profound **hypotension** and severe **respiratory distress** seen here.
- While a slight temperature elevation occurred, the overwhelming cardiovascular collapse is not typical.
*Acute hemolytic transfusion reaction*
- Usually presents with **fever**, **chills**, **flank pain**, **dark urine** (hemoglobinuria), and sometimes hypotension due to **ABO incompatibility**.
- Onset can be rapid but typically includes more evidence of **hemolysis** (jaundice, hemoglobinuria).
- The immediate and severe respiratory compromise is less typical compared to anaphylaxis.
*Transfusion-related acute lung injury (TRALI)*
- Presents primarily with **acute respiratory distress**, **hypoxemia**, and **bilateral pulmonary infiltrates** within six hours of transfusion.
- Usually occurs **1-6 hours** post-transfusion, not within minutes.
- While respiratory distress is present, the immediate and profound circulatory collapse with such rapid onset points toward anaphylaxis rather than TRALI.
*Bacterial contamination of blood products*
- Can present with **septic shock**: fever, hypotension, and tachycardia following transfusion.
- However, the **respiratory distress** and **immediate onset** within minutes are more characteristic of anaphylaxis.
- Bacterial contamination typically has a slightly more gradual onset and may show signs of sepsis.
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